Corticosteroids are a group of anti-inflammatory drugs similar to the hormone cortisol produced in the body. Corticosteroids reduce the inflammation associated with many diseases, including many forms of arthritis.
They can be taken in a variety of forms, such as pills, injections, inhalers, nasal sprays, topical creams, drops, ointments, enemas, foams and suppositories. Most corticosteroids are available only with a physician’s prescription. However, some topical creams are available over the counter.
Corticosteroids are used to treat a wide variety of conditions and diseases, such as joint pain, cancer, asthma and allergies. The oral and injected types of corticosteroids form a major part of treatment plans for many chronic pain conditions. Many inflammatory conditions, such as rheumatoid arthritis and gout, are first treated with nonsteroidal anti-inflammatory drugs (NSAIDs). If these drugs do not control the symptoms, corticosteroids are often the next line of treatment.
Corticosteroids can have a wide variety of serious side effects, particularly when oral forms are taken for long periods. These include acne, weight gain, diabetes, osteoporosis and decreased immune response. Many medications can interfere with corticosteroids. For these reasons, the medication should be taken only under the guidance of a physician.
Corticosteroids are different from the anabolic steroids taken by some athletes to enhance performance. That type of steroid is banned in many sports.
About corticosteroids
Corticosteroids are medications chemically related to the natural hormones produced by the adrenal glands, which are located at the top of each kidney.
Corticosteroids are synthetic versions of the natural hormone cortisol. Cortisol plays an important role in controlling salt and water balance in the body and regulating metabolism of carbohydrates, fats and proteins. When the body becomes stressed from infection, trauma, surgery or emotional problems, the adrenal glands produce more cortisol, which helps the body to cope with the stress. When the stress disappears, production of cortisol returns to normal. Cortisol also suppresses inflammation, which is the body’s normal response to outside invaders such as bacteria.
Corticosteroids work by blocking the production of substances in the immune system (such as prostaglandins) that trigger allergic and inflammatory reactions. Some autoimmune disorders also trigger inflammation when they react to normal body tissue as if it were an outside invader. This inflammation may first be treated with nonsteroidal anti-inflammatory drugs (NSAIDs). If NSAIDs do not provide relief from pain or inflammation, corticosteroids may be the physician’s next choice.
Corticosteroids are strong medications. Although they have proven to be helpful in treating many medical disorders, they have side effects that can be serious. The potential risks and benefits should be discussed with a physician before taking them.
People who take corticosteroids for painful conditions such as osteoarthritis, rheumatoid arthritis, gout or temporal arteritistemporal arteritis usually take pills or receive injections. For people with one painful joint, such as a knee, injection therapy can reduce pain and swelling. Corticosteroids injected into a joint can concentrate the medication where it is needed and avoid potential problems. However, continued injections into joints may eventually damage the cartilage.
Most corticosteroids are available only with a physician’s prescription. However, some low-strength topical creams are available over the counter.
People taking corticosteroids for a long period of time should not stop taking them abruptly because they can experience serious side effects. A physician can provide a schedule for safely discontinuing the use of corticosteroids.
Corticosteroids should not be confused with anabolic steroids, which are sometimes taken by bodybuilders and other athletes to enhance performance. Many sports prohibit the use of anabolic steroids, which help build muscle tissue and increase body mass.
Types and differences of corticosteroids
Corticosteroids can be administered by various methods, depending on the condition being treated. Most conditions and diseases that involve chronic pain and inflammation use the oral or intravenous forms. The main methods of corticosteroid administration include:
Oral methods (e.g., pills, liquids). Medication is swallowed and absorbed into the bloodstream, where it spreads throughout the body.
Intravenous methods. Medication is injected under the skin through a needle and syringe. It enters the bloodstream and spreads throughout the body. It can also be given intramuscularly, where the medicine is deposited in the muscle to work longer than an intravenous injection. Corticosteroids may also be injected directly into an inflamed joint, such as during an acute attack of gout or rheumatoid arthritis.
Topical creams. Medication is applied directly to the skin.
Ointments/drops. Eyes are treated with ointment or drops. Ears are treated with drops.
Paste. Medication is applied to the mouth and gums.
Enemas/foams/suppositories. Medication is applied rectally.
Inhaled methods (e.g., inhalers, nebulizers). Medication is breathed deep into the lungs and comes into contact with the mucous membranes of the lungs.
Nasal sprays. Medication is inhaled into the nose and sinuses where it comes into contact with the walls of the sinuses. With this form of treatment, the medication does not reach the lungs.
There are also combination products, such as a corticosteroid with an antifungal or antibiotic.
Conditions treated with corticosteroids
Corticosteroids are prescribed for a variety of conditions, including:
Back pain. Back pain, from conditions such as herniated discs, is sometimes treated with corticosteroids. This is especially true during the acute phase. The medication is usually injected. Recent research indicates that a radionuclide imaging test called a SPECT scan (single-photon image computed tomography) can help identify which back patients will benefit from corticosteroid injections and which will not.
Joint pain. Injections into a joint, such as for tennis elbow, an arthritis-afflicted knee or TMJ disorder, can reduce acute and chronic pain and restore function.
Tendinitis (inflammation of a tendon) and bursitis (inflammation of a bursa). These conditions, in areas such as elbows and shoulders, are sometimes treated with injections of corticosteroids.
Temporal arteritis. An inflammation of large arteries, most often the temporal arteries of the head. The standard treatment is corticosteroids.
Carpal tunnel syndrome. Condition caused by an inflammation of the wrist that puts pressure on a nerve, causing pain. Corticosteroids are capable of providing pain relief by reducing inflammation and pressure in the wrist.
Eye disorders. Ophthalmic corticosteroids (which come in the form of ointments or drops) are used to treat eye problems and reduce swelling, itching and discomfort. Many forms of juvenile arthritis include eye inflammations that may be treated with corticosteroid drops.
Ear disorders. Otic corticosteroids (which come in the form of drops) are used to treat ear problems.
Skin disorders. Topical creams containing corticosteroids are used to treat a variety of skin problems, such as atopic dermatitis (eczema). This is a skin condition usually characterized by itching and a red, raised rash.
Headaches. Corticosteroids are sometimes used as headache medications.
Rectal disorders. Rectal corticosteroids (which come in the form of enemas, foams or suppositories) are used to treat rectal problems, such as inflammatory bowel conditions (e.g., ulcerative colitis, Crohn’s disease). They can also be used to help relieve swelling, itching and discomfort from other rectal problems, such as hemorrhoids.
Cancer pain. Some types of cancerous growths cause swelling and pain. Corticosteroids are able to relieve swelling and reduce the amount of pain associated with this condition.
Systemic lupus erythematosus (SLE). Corticosteroids are able to treat inflammation and control many of this autoimmune condition’s moderate to severe symptoms. However, a common complication of SLE is osteoporosis, a condition of concern with corticosteroids.
Other autoimmune diseases.
Allergies (e.g., hay fever, allergic sinusitis). Exaggerated or inappropriate reaction of the immune system to any substance that, in most people, causes no symptoms. Applying corticosteroids directly to the mucous membranes (using inhalers or nasal sprays) can reduce or prevent inflammation due to allergen contact.
Asthma. Condition in which the airways become blocked or narrowed, causing shortness of breath and difficulty breathing. Corticosteroids are used to reduce or prevent inflammation of the bronchial tubes. They may also help treat chronic cough caused by asthma, gastroesophageal reflux disease (GERD) or other conditions.
Cystic fibrosis. Genetic disease characterized by respiratory problems due to poor salt absorption. Corticosteroids are used to treat the inflamed tissues in the respiratory tract often associated with cystic fibrosis.
Other lung disorders. Use of corticosteroids has been controversial with chronic obstructive pulmonary disorder (COPD), a common cause of chest pain. However, several recent studies have found that use of inhaled corticsteroids can reduce mortality in people with COPD.
Multiple sclerosis (MS). Chronic neurological disease of the central nervous system. Corticosteroids reduce MS attacks by reducing spinal cord and brain inflammation.
Nephrotic syndrome. Kidney disorder involving low levels of protein in the blood. Corticosteroids help restore normal function to the kidneys by reducing inflammation.
In addition, recent research suggests that injections of corticosteroids in people with rheumatoid arthritis may, in addition to easing their joint pain, reduce their increased risk of lymphoma (lymphatic cancer). Further study would be needed to establish such a connection.
Conditions of concern with corticosteroids
Use of corticosteroids should always be closely monitored by a physician. The medications should be taken only as prescribed and completed as directed. The body needs to adjust after taking corticosteroids, and any unsupervised cessation may cause problems.
People with certain diseases or conditions should not take corticosteroids. A physician may recommend against use of corticosteroids by patients diagnosed with any of the following conditions, most of which occur when corticosteroids are used for longer periods:
Diabetes, prediabetes or family history of diabetes. Some types of corticosteroids affect control of glucose (blood sugar). In addition, the American Diabetes Association (ADA) cautions that steroids are toxic to the insulin-producing cells of the pancreas and can cause insulin resistance, a major risk factor for diabetes.
A former president of the ADA has warned that the effect of corticosteroids on blood sugar is commonly underestimated, and that these drugs can cause steroid-induced diabetes and can cause dangerous bouts of high glucose (hyperglycemia) in patients who already have diabetes. Steroid-induced diabetes may resolve after the medication is discontinued, unlike other forms of diabetes, which are considered permanent, with the exception of gestational (pregnancy-induced) diabetes.
Liver diseases. Corticosteroids may not be eliminated from the body at the usual rate when used with this condition. In addition, inhaled corticosteroids may have a stronger effect on individuals with cirrhosis.
Glaucoma. Eye disease involving damage to the optic nerve, usually caused by increased pressure inside the eye. Corticosteroids can cause the pressure in the eye to further increase.
Osteoporosis. Condition involving decreased bone density. Osteoporosis is also a possible complication of other conditions, including systemic lupus erythematosus (SLE) and diabetes. High doses of corticosteroids can cause osteoporosis to worsen because they cause the body to lose even more calcium. The American College of Rheumatology advises that patients on long-term corticosteroid therapy receive bisphosphonate drugs to avoid bone loss. However, research indicates that many such patients are not getting this treatment.
Hypothyroidism. Decreased production of thyroid hormone. Inhaled corticosteroids may have a stronger effect in individuals with this condition.
Infections. Corticosteroids can suppress the body’s immune function and cause infections to worsen if left untreated.
Reduced wound healing. Corticosteroids can cause delay in wound healing.
Chickenpox, measles, or recent exposure to these conditions. Contagious skin diseases can spread to other parts of the body when using corticosteroids.
Tuberculosis. Infectious bacterial disease. Corticosteroid use can cause infections to return in individuals with a history of tuberculosis due to immunosuppression (weakening of the immune system).
AIDS (acquired immunodeficiency syndrome). Viral disease that weakens the immune system. Corticosteroids can interfere with the treatment of this condition.
Strongyloides. Worm infestation. Corticosteroids can cause the condition to heal more slowly or worsen the infection.
Amebiasis. Infection from an ameba (one-celled organism). Some types of nasal corticosteroids worsen this condition.
Weight gain. Corticosteroids can increase appetite and cause excessive weight gain.
Psychosis. Corticosteroids can worsen this mental disorder.
Cardiomyopathy (weakened heart muscle), atrial fibrilation (an abnormal heart rhythm) or other heart disease. Some types of corticosteroids can worsen these conditions.
Kidney stones or other kidney disorders. Treatment of kidney disease, particularly with dialysis, can be disrupted by the excess water retention that often accompanies use of corticosteroids.
High blood pressure. Corticosteroids can exacerbate this condition by causing the body to retain extra water.
High cholesterol. Corticosteroids can increase blood cholesterol levels.
Stomach ulcer, ulcerative colitis or other gastrointestinal problem. Corticosteroids can mask the symptoms of a serious stomach or intestinal condition.
Myasthenia gravis. Muscle weakness caused by this condition could be exacerbated by corticosteroids.
Potential side effects of corticosteroids
Corticosteroids provide short-term relief for many chronic pain conditions. They are some of the most powerful medicines available to fight inflammation. However, long-term use of corticosteroids may lead to numerous side effects, including diabetes. Some of the strongest side effects are associated with the oral and intravenous forms of corticosteroids, which are used for pain. Physicians may try to minimize the side effects by prescribing as low a dose as possible for pain relief and by using corticosteroids for severe pain only.
Corticosteroids can cause a form of Cushing’s syndrome. This condition can also result from overproduction of adrenal hormones due to diseases such as cancer. Symptoms of Cushing’s syndrome include weight gain (notably in the abdomen), fleshiness in the face, accumulation of fat between the shoulders, back pain, unexplained euphoria, headache, erectile dysfunction or amenorrhea (absence of menstruation), and skin changes including acne, increased bruising and formation of purple lines on the thighs, belly and breasts. Drug-induced Cushing’s syndrome generally resolves after the medication is discontinued.
Common side effects of corticosteroids include:
Oral and intravenous:
Suppression of the immune system, increasing likelihood for infection
Bone loss, which may lead to or exacerbate osteoporosis
Cartilage damage after repeated injections
Acne
Weight gain
Mood swings
Delayed growth (in children)
Blurred vision
Excessive urination (polyuria)
Increased thirst (polydipsia)
Increased appetite (polyphagia)
Indigestion
Flushing of face or cheeks
Increase in glucose (blood sugar)
Ointments/drops:
Eye infection
Eye pain
Gradual blurring or loss of vision
Nausea/vomiting
Inhaled corticosteroids:
Sore mouth or throat, hoarseness
Coughing
Thrush (fungal infection in the mouth)
Decrease in bone thickness
High pressure or fluid buildup in the eye
Nasal spray corticosteroids:
Increased chance of bruising
Skin or muscle wasting
Weight gain or fluid retention
Decrease in bone density
Damage to bones and bone cells (avascular osteonecrosis)
Increased blood pressure
Increased risk of ulcer
Increased risk of eye complications, such as glaucoma or cataracts
Topical corticosteroids:
Skin blisters filled with blood
Itching or burning skin
Increased skin sensitivity
Numbness in the fingers
Increased chance of bruising
Raised red spots on the skin
Enemas/foams/suppositories:
Burning or itching of skin
Diarrhea
Infection
Rectal bleeding
Sensation of pins and needles
Pastes:
Infection
Irritation, such as burning, itching, blistering or peeling
Some side effects of corticosteroid drugs are considered more dangerous, though rare. An individual should immediately contact a physician if they experience any of these side effects:
Loss of vision or eye pain
Unusual confusion or excitement
Hallucinations
Mental depression
Irregular heartbeat
Bloody stool
Unusual increase in hair growth
Vomiting
Drug or other interactions with corticosteroids
Patients should consult their physician before taking any additional prescriptions, over-the-counter medications, nutritional supplements, herbal medications or certain foods. Of particular concern to individuals taking corticosteroids are:
Diuretics (water pills). Can cause the diuretic to be less effective and may increase the loss of potassium.
Medicines containing potassium, such as some thyroid drugs. Can interfere with potassium levels in the blood.
Medicines containing sodium. Can cause the body to retain excess sodium and water, which can cause high blood sodium (hypernatremia), high blood pressure and excess body water.
Heart medications. Can increase the risk of having an irregular heartbeat or other problems by decreasing the amount of potassium in the blood.
Cyclosporine(used to suppress the immune system for autoimmune disorders, such as rheumatoid arthritis, in addition to preventing transplanted organ rejection). Can cause seizures when taken with some corticosteroids.
Insulin or other diabetes drugs (antidiabetic agents). Can increase glucose (blood sugar) when taken with corticosteroids.
Licorice (candy made from the licorice plant’s root). Can increase the effects of corticosteroid medications.
Antacids (counteracts stomach acidity). Can decrease the effectiveness of some corticosteroids.
Anticonvulsants (used to treat seizures and other conditions, including neuropathic pain). Can decrease the effectiveness of some corticosteroids.
Phenylbutazone (a nonsteroidal anti-inflammatory drug used to treat fever, pain and inflammation). Can reduce the effectiveness of corticosteroids.
Aminoglutethimide (used to treat some tumors and adrenal conditions).Can reduce the effectiveness of corticosteroids.
Griseofulvin (used to treat skin infections). Can reduce the effectiveness of corticosteroids.
Ephedrine (central nervous system stimulant). May decrease the effectiveness of nasal corticosteroids.
Ritodrine (used to stop premature labor). Can cause serious side effects when taken with corticosteroids.
Rifampin (antibacterial drug used to treat tuberculosis). May decrease the effectiveness of nasal corticosteroids.
Barbiturates (group of drugs used as sedatives and headache medications). Can decrease the effectiveness of some corticosteroids.
Mitotane (used to treat cancers that affect the adrenal cortex). Can decrease the effectiveness of some corticosteroids.
Amphotericin B by injection(used to treat fungal infections). Can decrease the amount of potassium in the blood.
Symptoms of corticosteroids overdose
Symptoms of overdose can be similar to the medication’s side effects but are usually more severe. Patients exhibiting any of these symptoms should contact their physicians immediately:
Bone fractures
High blood pressure
Increased blood sugar
Increased urination
Increased thirst
Blurred vision
Excessive weight gain
Fullness in the face, neck or trunk
White patches in throat
Acne
Impotence (men)
Menstrual changes or excessive hair growth (females)
Pregnancy use issues with corticosteroids
Most physicians agree that the rewards of using corticosteroids for some types of conditions often outweigh the risks. However, pregnant women should always discuss the use of corticosteroids with their physicians before using the medication.
Animal studies have demonstrated that oral and intravenous use of corticosteroids during pregnancy can cause birth defects. Using a higher dosage of corticosteroids has also been shown to cause unwanted effects during a pregnancy, including slower infant growth and problems with the adrenal glands. These problems were more likely to occur if the higher dosage was taken in the first trimester.
Breastfeeding women should exercise caution when nursing. Though most types of corticosteroids do pass into breast milk, they are generally present at such low levels that they do not affect the infant. However, the corticosteroid dexamethasone has been linked to slow growth in nursing infants when used by the mother. Breastfeeding mothers should consult their physicians before taking corticosteroids.
Nasal corticosteroids are generally considered to be safer than intravenous or oral corticosteroids. Using a nasal corticosteroid in place of an oral or intravenous corticosteroid during pregnancy is often recommended by a physician, when possible.
Studies have shown that daily use of almost all types of inhaled corticosteroid drugs while pregnant (at normal dosage) does not cause birth defects or other problems. However, testing has shown that corticosteroids can cause birth defects in animals.
Child use issues with corticosteroids
Corticosteroids have a range of side effects that tend to be more pronounced in children than in adults. A child should never take any type of corticosteroid treatment without first seeing a physician.
Children who are using corticosteroid drugs and contract certain infections (e.g., chickenpox) may experience more severe infections. To avoid this, a physician may recommend vaccinations for some types of infection or suggest an alternative treatment, if appropriate.
Children and teenagers who take corticosteroids can experience delayed growth, particularly if the medication has been taken for a long period of time. This is due to the medication’s interference with the function of the adrenal glands.
An injection of corticosteroids is often given to young children who have a hard time swallowing the foul-tasting liquid form of the medication. Some children vomit after taking the liquid form. The effectiveness of a corticosteroid injection is comparable to that of the liquid form taken by mouth. Research has shown that long-term use of inhaled corticosteroids in asthma patients does not retard growth eventually.
Elderly use issues with corticosteroids
Some older individuals will experience side effects that are more pronounced. Older adults have an increased risk of developing high blood pressure or osteoporosis (bone disease) when taking corticosteroid drugs.
Questions for your doctor
Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about corticosteroids:
Why are you prescribing this medication for me?
What type of corticosteroids should I take to treat my condition?
What are the most common side effects I can expect? Am I likely to experience Cushing’s syndrome?
Is it safe for me to take corticosteroids if I have a personal or family history of diabetes, prediabetes, glaucoma, osteoporosis or other conditions of concern?
How do corticosteroids interact with other drugs I take?
How do I know if I am having problems with the drugs?
Can I change to a different type if I have problems with the one prescribed?
What is the safest amount of time I can stay on these drugs?
Would I benefit from taking osteoporosis medication to preserve my bone health while using corticosteroids?
What signs of corticosteroid overdose should I watch for?
Are there special considerations to taking these drugs if I’m pregnant?
